摘要
目的探讨功能性单心室合并中重度房室瓣反流外科治疗的早中期结果及再干预的预后因素。方法回顾性分析广州市妇女儿童医疗中心心外科2008年1月至2017年12月收治的功能性单心室合并房室瓣中重度反流接受房室瓣干预的40例患者的临床资料。男性25例,女性15例。初次干预时年龄为4.5~204.0个月[M(QR):42.5(59.7)个月],体重为6.0~55.4kg[M(QR):13.8(8.1)kg]。房室瓣形态特征包括共同房室瓣21例,单组二尖瓣7例,单组三尖瓣3例,两组房室瓣9例。初次干预前房室瓣重度反流者15例,中度反流者25例。干预时机:第一期姑息手术或Glenn术前5例,第二期Glenn手术同期23例,Glenn术后Fontan术前间隔期4例,Fontan手术同期8例。干预方法:房室瓣成形术31例,房室瓣置换术9例。采用Kaplan-Meier法估算生存时间,采用Cox回归探讨再干预的预后因素。结果早期死亡6例,病死率为15%。随访1~117个月44(34)个月]。术后1、5和10年生存率分别为85.0%(95%CI:74.0%~95.9%)、79.3%(95%CI:66.6%~92.0%)和79.3%(95%CI:66.6%~92.0%)。13例患者完成Fontan手术。6例患者进行8次再干预,包括房室瓣置换5例,房室瓣再次成形3例。初次术后1、5年免于房室瓣再干预率为89.8%(95%CI:78.8%~100%)、79.4%(95%CI:64.7%~94.1%)。多因素分析结果显示,共同房室瓣(HR=3.53,95%CI:1.63~7.67,P=0.020)是初次干预术后再干预的预后因素。结论功能性单心室合并中重度房室瓣反流外科治疗的早中期结果欠佳,手术病死率和再干预率高。合并共同房室瓣是远期房室瓣再干预的预后因素。
Objective To evaluate the early-and mid-term outcomes of surgical atrioventricular valve (AVV) intervention in patients with functional single ventricle (FSV).Methods The clinical data of 40 consecutive FSV patients who underwent surgical AVV intervention between January 2008 and December 2017 at Department of Cardiac Surgery,Guangzhou Women and Children's Medical Center,Guangzhou Medical University were reviewed retrospectively.There were 25 male and 15 female patients.The median age at AW intervention was 4.5 to 204.0 months (M(QR):42.5 (59.7) months),and the median body weight was 6.0 to 55.4 kg (M (QR):13.8 (8.1) kg).The systemic AVV morphology included common AVV in 21 patients,mitral valve in 7 patients,tricuspid valve in 3 patients,and both mitral and tricuspid valve in 9 patients.At first surgical intervention,15 patients had severe,25 patients had moderate AVV regurgitation.The timings of the initial surgical intervention were at the first palliative,Glenn,between Glenn and Fontan,and Fontan stage in 5,23,4,and 8 patients,respectively.The methods of the initial surgical intervention were AVV repair in 31 patients,AVV replacement in 9 patients.Actuarial survivals were estimated by the Kaplan-Meier method.Prognosis factors for atrioventricular valve reoperation were analyzed using the Cox regression hazard model.Results There were 6 early deaths,with a mortality of 15.0％.Thirty-four survival patients received a follow-up of 1 to 117 months (M (QR):44 (34) months).Survival of patients after the initial surgical intervention were 85.0％ (95％ CI:74.0％ to 95.9％),79.3％ (95％ CI:66.6％ to 92.0％),and 79.3％ (95％ CI:66.6％ to 92.0％) at 1 year,5 years and 10 years,respectively.In all,only 13 patients completed the Fontan procedure.Six patients underwent 8 reoperations,including AVV replacement in 5 patients,redo AVV repair in 3 patients.Freedom from AVV reoperation at 1 and 5 years was 89.8％ (95％ CI:78.8％ to 100％) and 79.4％ (95％ CI:64.7％ to 94.1％),respectively.Multivariate Cox r
作者
邹明晖
曹凡
马力
夏园生
杨盛春
陈伟丹
李文雷
陈欣欣
Zou Minghui;Cao Fan;Ma Li;Xia Yuansheng;Yang Shengchun;Chen Weidan;Li Wenlei;Chen Xinxin(Department of Cardiac Surgery,Guangzhou Women and Children's Medical Center,Guangzhou Medical University,Guangzhou 510623,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2018年第12期922-927,共6页
Chinese Journal of Surgery
关键词
心脏缺损
先天性
单心室
房室瓣反流
Heart defects,congenital
Single ventricle
Atrioventricular valve regurgitation
